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From 1984 to 1995, 68 ankylosed elbows and 11 which were unstable after trauma were replaced in India by Baksi sloppy hinge prostheses. The mean age of the patients was 28.6 years (17 to 70) and the mean follow-up 9.6 years (2 to 13.5).

Of the 68 ankylosed elbows, 59 (87%) regained a mean arc of painless movement of 88.5 deg (27 to 115). The mean improvement of supination was 24 deg and of pronation 16.5 deg. There were 54 good results (80%), eight fair and three poor. There were two complete failures due to infection, and one due to a broken humeral stem.

Of the 11 unstable elbows, the nine with good results had a mean are of 125 deg (15 to 140) of painless stable movement, with a mean improvement in supination of 26 deg and of pronation of 19.5 deg. There was one fair result and one failure due to loosening with subsequent late infection.

There were significant complications in 14 cases with infection in seven and aseptic loosening in four. Patients with loosening or late removal of the prosthesis often retained reasonably stable elbow movement because periprosthetic fibrosis had connected the approximated bone ends, and muscle balance had been restored.

J Bone Joint Surg [Br] 1998;80-B:614-9.

Received 1 October 1997; Accepted after revision 13 January 1998

Post-traumatic ankylosis or instability of the elbow is fairly common in developing countries, because of inadequate primary treatment. The poor long-term results of interposition arthroplasty and resection have led to consideration of replacement arthroplasty, but constrained prostheses which do not allow the dissipation of forces at the elbow have shown an unacceptably high rate of early loosening,1,2 especially in post-traumatic arthritis.3,4 Current semiconstrained designs are reported to give more encouraging results,5-7 even in young adults,8 but unconstrained resurfacing prostheses are not practical in post-traumatic cases with deformity, incongruity, soft-tissue damage and bony ankylosis. Semiconstrained implants with pin-stabilised, but loose, hinges avoid the potential for dislocation or subluxation.

The mid-term follow-up is reported of a locally designed and manufactured sloppy hinge prosthesis, similar to other semiconstrained implants, for post-traumatic ankylosed and unstable elbows.

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